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Hard Deposits and Exploring. §Objectives l Describe calculus and name the various surfaces on which it can form. l Describe the similarities and differences.

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Presentation on theme: "Hard Deposits and Exploring. §Objectives l Describe calculus and name the various surfaces on which it can form. l Describe the similarities and differences."— Presentation transcript:

1 Hard Deposits and Exploring

2 §Objectives l Describe calculus and name the various surfaces on which it can form. l Describe the similarities and differences between supragingival and subgingival calculus deposits. l Name 3 methods for identification of supragingival calculus and 5 methods for identification of subgingival calculus. l Describe the process of calculus formation. l Compare the hardness of calculus to that of enamel, dentin, cementum, and bone.

3 Hard Deposits and Exploring Objectives Cont. l Discuss the relationship between calculus and dental disease. l Identify 3 modes for attachment of calculus to a tooth surface. l Describe the composition of calculus. l Identify 6 uses of a dental explorer. l Describe the design and use of the #17, #23, and ODU 11/12 explorers. l Demonstrate appropriate use of the #17, #23, and ODU 11/12 explorers on the dentoform.

4 Hard Deposits §Calculus l Calcified bacterial plaque l Hard, tenacious mass forming on teeth (primary or permanent), dentures, & other dental appliances

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7 Hard Deposits §Location l Supragingival l Subgingival

8 Hard Deposits §Identification l Supragingival calculus l Subgingival calculus

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10 Hard Deposits §Calculus formation l Pellicle --> (colonization) --> Plaque --> (mineralization) --> Calculus l Saliva provides elements for calcification of supragingival deposits l Gingival sulcus fluid provides elements for mineralization of subgingival deposits l Average time for plaque to mineralize into calculus is 12 days (Range= 10 to 20 days) l Mineralization of plaque may begin as soon as 12 to 24 hours l Forms in layers parallel with tooth surface l Incremental lines form between layers of calculus

11 §Hardness of calculus % inorganic substance 96% enamel 75-85% calculus 65% dentin 45-50%cementum/bone **the higher the inorganic %, the greater the degree of calcification Hard Deposits

12 §Relationship to disease l Calculus is a plaque haven l Calculus is the result (NOT the cause) of pocket formation l Plaque forming on top of calculus is nearly impossible to remove (rough surface harbors plaque; tears floss) l If calculus is removed, the smooth tooth surface makes plaque removal effective l Calculus holds toxic by-products of plaque in contact with gingival tissues

13 Hard Deposits §Modes of attachment l Acquired pellicle- easily removed because there is no mechanical interlock l Mechanical interlock- locked into irregularities (rough cementum, caries, enamel cracks). Difficult to remove and difficult to assess when complete l Direct contact between tooth and calculus matrix- difficult to remove

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15 Hard Deposits §Composition l Mature calculus 75-85% inorganic components (calcium, phosphate, trace elements, fluoride, hydroxyapatite crystals) 15-25% water and organic components (microorganisms, desquamated epithelial cells, leukocytes)

16 Exploring §Uses of the explorer - Detection of:

17 Exploring §Design l Working end flexible, wire-like circular in cross-section last 1-2mm is referred to as the TIP tapers to a sharp POINT single-ended or double-ended (paired or dissimilar ends) l Shank straight or curved very flexible

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19 Exploring §#17 Explorer l Tip is at a right angle to the shank l Used supragingivally and subgingivally but NOT for caries detection in pits and fissures l Good for deep pockets and anterior teeth

20 Exploring §#23 Explorer l “Shepard’s hook” l Used primarily for caries detection (use is now controversial- some evidence that clinician may actually penetrate thin but sound enamel with explorer tip) l Does not adapt well subgingivally

21 Exploring §ODU 11/12 l Double ended with paired working ends l Works well in all segments with shallow sulcus depths

22 Exploring §Tactile sensitivity l Ability to distinguish relative degrees of roughness and smoothness l Takes a lot of time and effort to refine

23 Exploring §Technique l Light (no blanching), modified pen grasp l Intraoral fulcrum on same arch (except maxillary posterior where it may be impossible to fulcrum on same arch) l Carefully insert into sulcus at distal line angle l SIDE of tip should be against tooth l BACK will reach junctional epithelium l Do not direct POINT apically l Critical that explorer reaches the base of the sulcus

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25 Exploring §Technique (cont.) l Adapt so TIP is flush against the tooth (Adaptation= placement of working end against tooth) l Use an exploratory stroke (feeling) l Pull motion from base of sulcus to marginal gingiva l “Bump” over large pieces of calculus; “drag” over smaller pieces; “fall” into large areas of decay; bump over or fall into defective restorative margins; smooth tooth surface

26 Exploring §Stroke direction l Vertical and oblique strokes should be used. This directs the explorer at a right angle to the deposit. l Horizontal strokes should be avoided. They may cause the explorer to run parallel to the deposit so it will not be detected. Point is directed toward JE- very dangerous! l Extend strokes at least 1/2 way across the interproximal surfaces. l Roll the explorer in your fingers to maintain adaptation l Use wrist action, NOT finger action

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28 Exploring §Practicing exploring techniques l Posterior techniques

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32 The following slides will give you an example of different degrees of calculus build up:

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